Health & Healthcare Disparities Committee
Filed: 3/12/2009
 
 

 




 

 		












09600HB0528ham002

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AMENDMENT TO HOUSE BILL 528




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    AMENDMENT NO. ______. Amend House Bill 528, AS AMENDED, by 
3
replacing the introductory clause of Section 5 with the 
4
following:

 
5
    "Section 5. The State Employees Group Insurance Act of 1971 
6
is amended  by changing Section 6.11 as follows:
 


7
    (5 ILCS 375/6.11)

8
    (Text of Section before amendment by P.A. 95-958)
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    Sec. 6.11. Required health benefits; Illinois Insurance 
10
Code
requirements.  The program of health
benefits shall provide 
11
the post-mastectomy care benefits required to be covered
by a 
12
policy of accident and health insurance under Section 356t of 
13
the Illinois
Insurance Code.  The program of health benefits 
14
shall provide the coverage
required under Sections 356g.5,

15
356u, 356w, 356x, 356z.2, 356z.4, 356z.6, 356z.9, 356z.10, 
16
356z.13
356z.11, and 356z.14, and 356z.15
of the
Illinois 
 


 






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Insurance Code.
The program of health benefits must comply with 
2
Section 155.37 of the
Illinois Insurance Code.

3
(Source: P.A. 95-189, eff. 8-16-07; 95-422, eff. 8-24-07; 
4
95-520, eff. 8-28-07; 95-876, eff. 8-21-08; 95-978, eff. 
5
1-1-09; 95-1005, eff. 12-12-08; revised 12-15-08.)

 
6
    (Text of Section after amendment by P.A. 95-958)

7
    Sec. 6.11. Required health benefits; Illinois Insurance 
8
Code
requirements.  The program of health
benefits shall provide 
9
the post-mastectomy care benefits required to be covered
by a 
10
policy of accident and health insurance under Section 356t of 
11
the Illinois
Insurance Code.  The program of health benefits 
12
shall provide the coverage
required under Sections 356g.5,

13
356u, 356w, 356x, 356z.2, 356z.4, 356z.6, 356z.9, 356z.10, 
14
356z.11, and 356z.12, 356z.13
356z.11, and 356z.14, and 356z.15 
15
of the
Illinois Insurance Code.
The program of health benefits 
16
must comply with Section 155.37 of the
Illinois Insurance Code.

17
(Source: P.A. 95-189, eff. 8-16-07; 95-422, eff. 8-24-07; 
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95-520, eff. 8-28-07; 95-876, eff. 8-21-08; 95-958, eff. 
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6-1-09; 95-978, eff. 1-1-09; 95-1005, eff. 12-12-08; revised 
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12-15-08.)
 
21
    Section 10. The Counties Code is amended  by changing 
22
Section 5-1069.3 as follows:
 
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    (55 ILCS 5/5-1069.3)

 


 






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    (Text of Section before amendment by P.A. 95-958)

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    Sec. 5-1069.3. Required health benefits.   If a county, 
3
including a home
rule
county, is a self-insurer for purposes of 
4
providing health insurance coverage
for its employees, the 
5
coverage shall include coverage for the post-mastectomy
care 
6
benefits required to be covered by a policy of accident and 
7
health
insurance under Section 356t and the coverage required 
8
under Sections 356g.5, 356u,
356w, 356x, 356z.6, 356z.9, 
9
356z.10, 356z.13
356z.11, and 356z.14, and 356z.15 of
the 
10
Illinois Insurance Code.  The requirement that health benefits 
11
be covered
as provided in this Section is an
exclusive power 
12
and function of the State and is a denial and limitation under

13
Article VII, Section 6, subsection (h) of the Illinois 
14
Constitution.  A home
rule county to which this Section applies 
15
must comply with every provision of
this Section.


16
(Source: P.A. 95-189, eff. 8-16-07; 95-422, eff. 8-24-07; 
17
95-520, eff. 8-28-07; 95-876, eff. 8-21-08; 95-978, eff. 
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1-1-09; 95-1005, eff. 12-12-08; revised 12-15-08.)

 
19
    (Text of Section after amendment by P.A. 95-958)
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    Sec. 5-1069.3. Required health benefits.   If a county, 
21
including a home
rule
county, is a self-insurer for purposes of 
22
providing health insurance coverage
for its employees, the 
23
coverage shall include coverage for the post-mastectomy
care 
24
benefits required to be covered by a policy of accident and 
25
health
insurance under Section 356t and the coverage required 
 


 






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under Sections 356g.5, 356u,
356w, 356x, 356z.6, 356z.9, 
2
356z.10, 356z.11, and 356z.12, 356z.13
356z.11, and 356z.14, 
3
and 356z.15 of
the Illinois Insurance Code.  The requirement 
4
that health benefits be covered
as provided in this Section is 
5
an
exclusive power and function of the State and is a denial 
6
and limitation under
Article VII, Section 6, subsection (h) of 
7
the Illinois Constitution.  A home
rule county to which this 
8
Section applies must comply with every provision of
this 
9
Section.


10
(Source: P.A. 95-189, eff. 8-16-07; 95-422, eff. 8-24-07; 
11
95-520, eff. 8-28-07; 95-876, eff. 8-21-08; 95-958, eff. 
12
6-1-09; 95-978, eff. 1-1-09; 95-1005, eff. 12-12-08; revised 
13
12-15-08.)
 
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    Section 15. The Illinois Municipal Code is amended  by 
15
changing Section 10-4-2.3 as follows:
 
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    (65 ILCS 5/10-4-2.3)

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    (Text of Section before amendment by P.A. 95-958)

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    Sec. 10-4-2.3. Required health benefits.   If a 
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municipality, including a
home rule municipality, is a 
20
self-insurer for purposes of providing health
insurance 
21
coverage for its employees, the coverage shall include coverage 
22
for
the post-mastectomy care benefits required to be covered by 
23
a policy of
accident and health insurance under Section 356t 
24
and the coverage required
under Sections 356g.5, 356u, 356w, 
 


 






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356x, 356z.6, 356z.9, 356z.10, 356z.13
356z.11, and 356z.14, 
2
and 356z.15 of the Illinois
Insurance
Code.  The requirement 
3
that health
benefits be covered as provided in this is an 
4
exclusive power and function of
the State and is a denial and 
5
limitation under Article VII, Section 6,
subsection (h) of the 
6
Illinois Constitution.  A home rule municipality to which
this 
7
Section applies must comply with every provision of this 
8
Section.


9
(Source: P.A. 95-189, eff. 8-16-07; 95-422, eff. 8-24-07; 
10
95-520, eff. 8-28-07; 95-876, eff. 8-21-08; 95-978, eff. 
11
1-1-09; 95-1005, eff. 12-12-08; revised 12-15-08.)

 
12
    (Text of Section after amendment by P.A. 95-958)
13
    Sec. 10-4-2.3. Required health benefits.   If a 
14
municipality, including a
home rule municipality, is a 
15
self-insurer for purposes of providing health
insurance 
16
coverage for its employees, the coverage shall include coverage 
17
for
the post-mastectomy care benefits required to be covered by 
18
a policy of
accident and health insurance under Section 356t 
19
and the coverage required
under Sections 356g.5, 356u, 356w, 
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356x, 356z.6, 356z.9, 356z.10, 356z.11, and 356z.12, 356z.13

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356z.11, and 356z.14, and 356z.15 of the Illinois
Insurance

22
Code.  The requirement that health
benefits be covered as 
23
provided in this is an exclusive power and function of
the 
24
State and is a denial and limitation under Article VII, Section 
25
6,
subsection (h) of the Illinois Constitution.  A home rule 
 


 






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municipality to which
this Section applies must comply with 
2
every provision of this Section.


3
(Source: P.A. 95-189, eff. 8-16-07; 95-422, eff. 8-24-07; 
4
95-520, eff. 8-28-07; 95-876, eff. 8-21-08; 95-958, eff. 
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6-1-09; 95-978, eff. 1-1-09; 95-1005, eff. 12-12-08; revised 
6
12-15-08.)
 
7
    Section 20. The Illinois Insurance Code is amended  by 
8
adding Section 356z.15 as follows:
 
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    (215 ILCS 5/356z.15  new)
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    Sec. 356z.15. Inpatient hospital care. A group or 
11
individual policy of accident and health insurance or managed 
12
care plan amended, delivered, issued, or renewed after the 
13
effective date of this amendatory Act of the 96th General 
14
Assembly that provides coverage for inpatient hospital care 
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shall not refuse coverage for services provided to an enrollee 
16
or recipient that are ordered by a physician in a hospital that 
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may subject the patient to observation status while undergoing 
18
evaluation and assessment for the illness or condition that 
19
resulted in their hospital stay.
 
20
    Section 25. The Illinois Public Aid Code is amended  by 
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changing Section 5-16.8 as follows:
 



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    (305 ILCS 5/5-16.8)


 


 






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    Sec. 5-16.8. Required health benefits. The medical 
2
assistance program
shall
(i) provide the post-mastectomy care 
3
benefits required to be covered by a policy of
accident and 
4
health insurance under Section 356t and the coverage required

5
under Sections 356g.5, 356u, 356w, 356x, and 356z.6, and 
6
356z.15 of the Illinois
Insurance Code and (ii) be subject to 
7
the provisions of Section 364.01 of the Illinois
Insurance 
8
Code.

9
(Source: P.A. 95-189, eff. 8-16-07; 95-331, eff. 8-21-07.)

 
10
    Section 30. The Medical Patient Rights Act is amended  by 
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changing Sections 2.04, 3, and 5  and adding Sections 2.06, 5.1, 
12
and 5.2 as follows:
 



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    (410 ILCS 50/2.04)  (from Ch. 111 1/2, par. 5402.04)



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    Sec. 2.04. 
"Insurance company" means (1) an insurance 
15
company, fraternal
benefit society, and any other insurer 
16
subject to regulation under the
Illinois Insurance Code; or (2) 
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a health maintenance organization, a limited health service 
18
organization under the Limited Health Service Organization 
19
Act, or a voluntary health services plan under the Voluntary 
20
Health Services Plans Act.

21
(Source: P.A. 85-677; 85-679.)

 
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    (410 ILCS 50/2.06  new)
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    Sec. 2.06. "Health insurance policy or health care plan" 
 


 






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means any policy of health or accident insurance provided by a 
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health insurance company or under the Counties Code, the 
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Municipal Code, the State Employees Group Insurance Act or 
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Medical Assistance provided under the Public Aid Code.
 



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    (410 ILCS 50/3)  (from Ch. 111 1/2, par. 5403)



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    Sec. 3. The following rights are hereby established: 

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    (a) The right of each patient to care consistent with sound 
8
nursing and
medical practices, to be informed of the name of 
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the physician responsible
for coordinating his or her care, to 
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receive information concerning his or
her condition and 
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proposed treatment, to refuse any treatment to the extent

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permitted by law, and to privacy and confidentiality of records 
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except as
otherwise provided by law. The patient has a right to 
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be informed at any time of his or her responsibility for 
15
payment of services provided based on the inpatient, 
16
outpatient, or observation status of the patient that may 
17
affect coverage by his or her health insurance policy or health 
18
care plan. 

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    (b) The right of each patient, regardless of source of 
20
payment, to examine
and receive a reasonable explanation of his 
21
total bill for services rendered
by his physician or health 
22
care provider, including the itemized charges
for specific 
23
services received.  Each physician or health care provider
shall 
24
be responsible only for a reasonable explanation of those 
25
specific
services provided by such physician or health care 
 


 






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provider.

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    (c) In the event an insurance company or health services 
3
corporation cancels
or refuses to renew an individual policy or 
4
plan, the insured patient shall
be entitled to timely, prior 
5
notice of the termination of such policy or plan.

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    An insurance company or health services corporation that 
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requires any
insured patient or applicant for new or continued 
8
insurance or coverage to
be tested for infection with human 
9
immunodeficiency virus (HIV) or any
other identified causative 
10
agent of acquired immunodeficiency syndrome
(AIDS) shall (1) 
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give the patient or applicant prior written notice of such

12
requirement, (2) proceed with such testing only upon the 
13
written
authorization of the applicant or patient, and (3) keep 
14
the results of such
testing confidential.  Notice of an adverse 
15
underwriting or coverage
decision may be given to any 
16
appropriately interested party, but the
insurer may only 
17
disclose the test result itself to a physician designated
by 
18
the applicant or patient, and any such disclosure shall be in a 
19
manner
that assures confidentiality.

20
    The Department of Insurance shall enforce the provisions of 
21
this subsection.

22
    (d) The right of each patient to privacy and 
23
confidentiality in health
care. Each physician, health care 
24
provider, health services corporation and
insurance company 
25
shall refrain from disclosing the nature or details of
services 
26
provided to patients, except that such information may be 
 


 






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disclosed to the
patient, the party making treatment decisions 
2
if the patient is incapable
of making decisions regarding the 
3
health services provided, those parties
directly involved with 
4
providing treatment to the patient or processing the
payment 
5
for that treatment, those parties responsible for peer review,

6
utilization review and quality assurance, and those parties 
7
required to
be notified under the Abused and Neglected Child 
8
Reporting Act, the
Illinois Sexually Transmissible Disease 
9
Control Act or where otherwise
authorized or required by law.  
10
This right may be waived in writing by the
patient or the 
11
patient's guardian, but a physician or other health care

12
provider may not condition the provision of services on the 
13
patient's or
guardian's agreement to sign such a waiver.

14
(Source: P.A. 86-895; 86-902; 86-1028; 87-334.)"; and


 
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by inserting immediately above Section 99 the following:
 
16
    "Section 95. No acceleration or delay. Where this Act makes 
17
changes in a statute that is represented in this Act by text 
18
that is not yet or no longer in effect (for example, a Section 
19
represented by multiple versions), the use of that text does 
20
not accelerate or delay the taking effect of (i) the changes 
21
made by this Act or (ii) provisions derived from any other 
22
Public Act.".